Healthcare Provider Details

I. General information

NPI: 1275352031
Provider Name (Legal Business Name): ANNA CATHERINE LEIST CRESWELL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE
ALBUQUERQUE NM
87106-2719
US

IV. Provider business mailing address

1712 PRINCETON DR SE
ALBUQUERQUE NM
87106-3114
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2211
  • Fax:
Mailing address:
  • Phone: 773-543-6352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number81248
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number81248
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number81248
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number81248
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: